Provider Demographics
NPI:1043290877
Name:DULA, VERONICA J (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:J
Last Name:DULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8321
Mailing Address - Country:US
Mailing Address - Phone:517-437-5390
Mailing Address - Fax:517-437-5382
Practice Address - Street 1:1711 S HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8321
Practice Address - Country:US
Practice Address - Phone:517-437-5390
Practice Address - Fax:517-437-5382
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104159413Medicaid
MI0M92590Medicare ID - Type Unspecified
MIH08656Medicare UPIN